ERDoc

You are right and wrong. The new CPR guidelines emphasize compressions in order to build up coronary perfusion pressure, not necessarily peripheral blood pressure. Perfusing the coronaries (and in turn the heart) is a good thing. A well perfused heart is usually a well oxygenated heart (hopefully). A well oxygenated heart is more likely to respond to the totures we place on it such as electrocution and chemistry. It also helps keep the brain perfused better (but the AHA guielines are written by cardiologists and in their world, nothing exists outside of the chest). Here are a few articles that may be of interest. http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum That should keep you entertained for a while. There are a few other good papers out there. Check the references from these papers or go to pubmed.

Read my post above. From what the literature is showing (albeit limited), what a trauma pt needs a surgeon (grits teeth) as quickly as possible. Even pts who were taken to outlying hospitals did worse than those taken to the trauma center. The way I take it is that less playing and more rapid transport to a trauma center is what the pt needs. Unfortunetly the outlying hospitals are bound by law to stabilize the pt prior to transport, which may not be in the pts best interest (again, from the limited literature). No matter how progressive your service is, I doubt you will be doing elaps or craniotomies, so more toys does not seem like the answer.

We have a winner. The guy has a seizure history and had a seizure. He is suffering from Todd's Paralysis which is a transient paralysis that occurs after a seizure. Usually it is not as diffuse as this guy has. Lots of good questions from everyone as ususal.

He answers no to cancer and yes to neurological. His speech is becoming more clear and he says seizure. He also says, "Scared...can't move." He denies any travel out of the country.

No obvious head injuries 126/74 Tympanic temp is 96.5 100% on RA

You can smell alcohol.

Your astute partner, thinking ahead as always, goes into the bar and finds a bunch of guys wearing shirts from the same fraternity. They said he was acting a little funny when they last saw him and assumed he was either in the bathroom or had left with a girl he was buying drinks for. A girl walks up to you and asks if you are the cops. When you say no, she tells you that she is the anonymous caller. She is underage, so she didn't want to get in trouble. She tells you that she was the one he was buying drinks for. They were having a good time, but he started talking funny and telling her he was seeing spots. He then got up from the bar. She assumed that he was just drunk and heading for the bathroom. She just happened to wander outside and found him laying on the floor, incoherent with a small trickle of blood coming from the corner of his mouth. Your Babinkski on the affected side is equivocal.

No history of trauma. Yes, he was drinking. Yes he has a medical problem. No illegal meds. Yes he is on a legal med. He answers no to syncope, yes to incontinence, no to sickness. No to family history.

Q1 Yes Q2 No Q3 Yes Q4 Yes Q5 No

I think you guys are misinterpreting some of the data. They accounted for differences in ISS (as well as other confounding variables) and there was still a statistically significant difference, though not as big as when you compare the crude groups. Though I haven't read the original article, just the abstract, I don't think we can come to the conclusion that the ISS was almost 10% more in the EMS subgroup. The abstract does not tell us what the ISS was for each subgroup. You can compare subgroups with unequal numbers. That is the purpose of using statistics. They allow you to mathematically and scientifically compare the two groups. I don't think anyone is saying that this is due to EMS ability, but more likely, as others on here have said, time to get the person to the trauma center. Another study showed that in pts who had equal transport times (EMS vs. nonEMS) there were equal outcomes. It also showed that in pts with ISS greater than 12, it took them longer to get to the hospital by EMS than it did by Homeboy Ambulance, but it did not look at the differences in outcomes of these pts. http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=10722034 There was also another study that showed that pts who were transported to a nontrauma center hospital first did worse than those who were taken directly to the trauma center. http://www.ncbi.nlm.nih.gov/entrez/query.f...st_uids=9291375

The pt is just outside a bar in early Sept. He is wearing a fraternity shirt and nice pants. He APPEARS intoxicated. He just laughs as you ask him questions, though he will answer yes/no questions. BGL is 156. When you ask him if he has ever had the paralysis before he tells you no.

It seems as if it has been a while since there has been a good scenario so I felt compelled to come up with one. Put on your thinking caps kiddies (it is 4am so this might not be as difficult as I hope it is). You are called to the intersection of Urbut and Stinx for a man down. Anonymous caller states there is an unconscious male on the sidewalk. PD notifies you that the scene is safe. You arrive to find a 21y/o male with slurred speech and left hemiparesis. As I typically do, I ask you to keep your questions to the history only at this point. We will come back to the physical exam later. Happy hunting.

You wouldn't even need to do it in a sterile fashion. Ever see how many nasty little bugs live in your intestines? You could probably drop the syringe or whatever you are using for delivery on the floor and it would still be cleaner. Definetly a possibility, though I would like to see some literature stating that there is enough uptake to make a difference. On a seperate note, anyone interested in being a participant in a study looking at a novel method of glucose delivery please PM me. Details to follow after you commit (how's that for informed consent? IRB anyone?).

It was in Utah. http://www.snopes.com/photos/accident/culvert.asp

Personally, I like to use Ativan for its longer action and I like Roc. As for this pt, why did the doc give narcan AFTER intubating? What is the use at that point? As someone else said, this is almost torture. I would have tried the narcan prior to intubation. If it worked I would have considered a narcan drip if more narcan was needed. Seems like he could have saved the pt a whole lot of problems and possibly a transfer.

Amphotericin B, daunorubicin, doxorubicin also have a lipid based preparation. The are many topical meds that are emulsions. Don't think any of these are relevant to the EMS setting.

On the poll there are 5 that have said no. I guess we can assume chicago is one of them. Let's hear from the other 4 (who hopefully have the ability to carry on a conversation without resorting to insults). Why do you feel that it is not important to have an education to care for patients?

Thanks Dwayne. I guess I could have googled it too, but I'm at work and didn't get a chance. Again, thanks for the info.

It is attitudes like this that will keep EMS in the 1960s. If you want to be considered a professional, then do what it takes to be professional. It has nothing to do with titles, it is all about education. With better education you can provide better and more informed care to your pts. Why are you against providing a higher level of care for your pts? Only when the dinosaurs with attitudes like this leave EMS will it become a profession and not a job.

Zippy, excuse my ethnocentrism, but what is a DipHE? As far as I know, we don't have any here in the US. Just so I can say that I didn't take yet anther thread off topic, I have a BS in Biochemistry, MD in doctor-like studies, 3 years of residency training and 100 hours of EMT education (with a few refreshers).

You've been able to synchronize over 250 rats! I can't get two to stand still at the same time. Rid, you never fail to amaze me.

Welcome to the City. Prepare to duck!! I'll sum up the responses that are coming. This has been discussed many times in the past. You can try using the search function. It depends on the training and your experience. A little more info is needed. How far out from EMT class are you? What kind of experience do you have?

Ruff, my understanding from what I read on the site that I posted was that she was on a private dock on the VT side, down approx 100 steps. The call to 911 was made from the NH side, which is probably why this company (from NH) was called out. I'm sure there were much better ways to handle it that would have had a better end result. It would suck to stair chair some up 100 steps, but that is the nature of the beast. Though I guess if they immobilized her, stair chair is out. We won't even comment on the immobilization (it's easy to play Monday morning quaterback).

:banghead: I find myself doing this a lot after reading the posts on here lately. How can anyone think that experience trumps education. Granted education also requires experience to be useful. If education is so useless, why is it required of so many other fields? I would have much rather taken a 12 month night class to become a doctor, but for some reason, someone thought it would be important for me to go through 4 years of undergrad, 4 years of med school and 3 years of residnecy to become an ER doc. The problem with depending on experience alone is that you don't know when you are doing something wrong. You also don't know how to keep up on the latest research. How many EMT/medic classes taught students how to do a literature search, read a real research article or to do a critical appraisal of the article. Medicine is not a static field. Things are constantly changing and if you don't know how to read the literature you will not know how to treat your pts properly. Guess you could make the arguement that that is what your protocols are for, but then you are nothing more than a technician. Until the attitude that education is not importnat is changed, it will be hard to go any further.